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Arquivos de Neuro-Psiquiatria

Print version ISSN 0004-282X

Arq. Neuro-Psiquiatr. vol.46 no.4 São Paulo Dec. 1988

http://dx.doi.org/10.1590/S0004-282X1988000400015 

Aneurisma gigante parasselar simulando tumor de hipófise

 

Giant paraselar aneurysm simulating pituitary tumour

 

 

Luiz Augusto Casulari Roxo da MottaI; Mário de Nazareth Hermes Jr.II; Marco Antonio de Arruda FigueiredoII; Antonio Ricardo Toledo GagliardiIII; Lucília Domingues Casulari da MottaIV; José Luiz F. de MendonçaV; Miguel Farage FilhoVI

IProfessor Visitante de Endocrinologia da Universidade de Brasília (UnB), Núcleo de Neuroendocrinologia do Hospital de Base do Distrito Federal (HBDF)
IIResidente da Unidade de Neurocirurgia do HBDF
IIIProfessor Assistente de Endocrinologia do HBDF
IVProfessora Assistente de Ginecología-Obstetrícia da UnB
VMédico da Unidade de Radiologia do HBDF
VIChefe da Unidade de Neurocirurgia do HBDF

 

 


RESUMO

Revisamos 7 pacientes com comprometimento da sela turca ao raio X do crânio que apresentavam aneurisma gigante da porção intracavernosa da artéria carótida (6 casos) e aneurisma da artéria comunicante anterior (1 caso). As alterações encontradas foram: cefaléia (7/7), oftalmoplegia complexa interessando III, IV e VI nervos cranianos (5/7) e comprometimento do V nervo (4/7), dor ocular (4/7). Outras alterações encontradas foram: sinais meníngeos (2/7), cegueira unilateral (1/7), hemiparesia (1/7) cacosmia (1/7) e quadrantanopsia bitemporal inferior (1/7). Cinco pacientes com aneurisma da porção intracavernosa da artéria carótida beneficiaram-se com a ligadura progressiva da artéria carótida interna a nível cervical; o outro paciente faleceu antes da realização da operação. O paciente com aneurisma da artéria comunicante anterior foi submetido a clipagem do aneurisma, tendo boa evolução. Baseados neste estudo e em concordância com a literatura, concluímos que o diagnóstico diferencial entre aneurisma localizado na região parasselar e outras patologias dessa área freqüentemente apresenta dificuldade. O diagnóstico definitivo requer a realização de angiografia cerebral. O tratamento cirúrgico, por ligadura da carótida interna na região cervical, é benéfico e quase desprovido de complicações.


SUMMARY

Seven cases of compromised pituitary fossa at the conventional skull X-ray, who had the final diagnosis of giant aneurysm of the intracavernous portion of the carotid artery (6 cases) and one of the anterior communicant artery, are reported. The main findings were: headache (7/7), complex ophtalmoplegia involving the III, IV and VI cranial nerves (5/7), compromised V cranial nerve (4/7) and eyeball pain (4/7). Other manifestations were: meningeal signs (2/7), unilateral blindness (1/7), hemiparesis (1/7), cacosmia (1/7) and inferior bitemporal quadrantanopsia (1/7). Five patients with intracavernous carotid artery aneurysm showed benefits with progressive occlusion of the internal carotid artery at the cervical level. One died before surgery. The case with anterior communicant artery aneurysm improved after its surgical clipping. Our data, in accord with the literature, support the conclusion that the differential diagnosis of aneurysms in the parasellar egion remains a very difficult task. The accurate final diagnosis requires cerebral angiography and the surgical treatment with progressive occlusion at the cervical portion of the internal carotid artery has a relatively low risk with promising results.


 

 

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REFERÊNCIAS

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Núcleo de Neuroendocrinologia, Unidade de Neurocirurgia, Hospital de Base do Distrito Federal - SMHS, Área Especial - 70335 Brasília DF - Brasil.

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